Provider Demographics
NPI:1427065234
Name:HEDGES, SHERYL ANN (NP,PMHNP)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:HEDGES
Suffix:
Gender:F
Credentials:NP,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SW OAK ST.
Mailing Address - Street 2:210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204
Mailing Address - Country:US
Mailing Address - Phone:503-988-3663
Mailing Address - Fax:
Practice Address - Street 1:12710 SE DIVISION ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236
Practice Address - Country:US
Practice Address - Phone:503-988-3601
Practice Address - Fax:503-988-4098
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090007034N6363L00000X, 363LC1500X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292317Medicaid
130175Medicare ID - Type Unspecified
OR292317Medicaid